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there were no mitotic figures (Fig. 1B). Immunohistochemically, the lesion was diffusely positive for cytokeratin 7 (Fig. 2), but negative for TFE3. Although I tried the immunohistochemistry of CA9, RCC Ma, CD10 and AMACR, the lesion disappeared because of its small size. The immunohistochemical phenotype of this small lesion seems to be consistent with that of clear cell papillary RCC [8, 9]. According to the recent classification, papillary adenoma is defined as tumor with papillary or tubular architecture of low nuclear grade and 5mm in diameter or smaller [10]. Accordingly, I suggest that small clear cell papillary lesion may be actually clear cell papillary adenoma as a precursor lesion of clear cell papillary RCC arising in ESRD or ACD [2, 3]. Otherwise, as the majority of previously reported clear cell papillary RCC showed pT1a in stage, I speculate that most cases with clear cell papillary RCC may be really benign neoplasm [4, 5, 11-14].

polish journal of pathology

Letter to the Editor Microscopic small clear cell papillary lesion of the kidney with long-term hemodialysis patient: Is this clear cell papillary adenoma?